tag:theconversation.com,2011:/us/topics/brain-stimulation-12690/articlesBrain stimulation – The Conversation2017-09-21T00:39:18Ztag:theconversation.com,2011:article/818862017-09-21T00:39:18Z2017-09-21T00:39:18ZExperimental brain technology can rewind Alzheimer's disease<p>Alzheimer’s disease is considered a <a href="http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(09)70298-4/abstract">global challenge of the century</a>. Alzheimer’s disease is a thief. It comes and takes away the most precious memories with which people identify themselves. It is a very clever thief. People whom it affects don’t even remember what they have lost — they just feel lost; lost in space and time.</p>
<p>Alzheimer’s can affect anybody: intellectuals, professors, artists, musicians and handymen. My mother’s Alzheimer’s motivated me to start the very first Repetitive Transcranial Magnetic Stimulation (rTMS) treatment for Alzheimer’s in Canada. </p>
<p>The treatment is a non-invasive procedure that doesn’t involve any medication. This technology has been used to successfully treat depression, and it is also being studied for a number of other neurological conditions (for example, Parkinson’s, concussion and stroke). </p>
<p>In rTMS, an electromagnetic coil is placed on the scalp and uses magnetic pulses to cause neurons (nerve cells) in the brain to activate. The goal is to train the neurons to perform better in the future. The rTMS treatment has no, or only mild side effects: some people report a slight headache that is easily treated with a pain relief pill. And the risk of seizure is very low. (Individuals with a history of epilepsy and/or seizures are excluded from rTMS treatments for that reason.)</p>
<h2>‘I remember’</h2>
<p>Our very first patient was a challenging 82-year-old lady at a relatively advanced stage of Alzheimer’s, who hated the treatment. Every time I asked her if she had children, she said: “Not yet; I’m still in my twenties!” </p>
<p>On the seventh day of the treatment, in the middle of session, she asked us to stop. Her husband tried to calm her and convince her to continue, saying: “Didn’t you want to remember our children?” </p>
<p>She replied: “But I do remember Susan, Sam and Dona; why do I need this stupid treatment?”</p>
<p>That moment was what I had dreamed to see in my late mother: the way she used to be, even for a few minutes. That patient’s cognitive state did not show any significant improvement over the course of treatment. However, her short moment of memory retrieval encouraged me to continue the rTMS treatment study on others as well — particularly on those at earlier stages of Alzheimer’s.</p>
<p>One thing to note and remember is that Alzheimer’s is a progressive degenerative disease. If we intervene to plateau the state of the patient or slow the progression, that is indeed an improvement and can be considered a positive effect of the treatment. </p>
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<figcaption><span class="caption">How rTMS treatment for Alzheimer’s disease works and is administered. (Zahra Moussavi)</span></figcaption>
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<p>In our pilot study, we gave a maintenance treatment every three months, to seven of our initial 10 participants, for up to a year and a half. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4457230/">Our results</a> showed that as long as patients were receiving the treatment, they did not decline. Some improved slightly. </p>
<p>As soon as we stopped the treatment (due to lack of funding), all patients started to show some decline. Three of them declined so severely that, within three months of stopping treatment, they ended up in a nursing home and passed away within a year.</p>
<p>Overall, our pilot study and similar small-sample studies around the globe showed encouraging results of rTMS treatment on Alzheimer’s, especially when it was applied at early and moderate stages. </p>
<h2>Encouraging steps to new Alzheimer’s treatment</h2>
<p>As a result of those pilot studies, the Weston Brain Institute has now funded the very first large placebo-controlled double-blind study of rTMS treatment on Alzheimer’s. This is a collaboration of three universities: University of Manitoba, McGill University and Monash University. The team includes engineers, psychiatrists, clinical psychologists, neurologists and statisticians. </p>
<p>The study is to investigate the effect of rTMS treatment on Alzheimer’s patients at early and moderate stages. All participants have to be diagnosed by one of the study doctors. And there are several assessments for before and after treatment to assess the efficacy of the treatment and how long it may last.</p>
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<span class="caption">Dr. Zahra Moussavi (centre) tests the rTMS unit with a single pulse, aided by members of her research team.</span>
<span class="attribution"><span class="source">(Zahra Moussavi)</span>, <span class="license">Author provided</span></span>
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<p>While this current study is an encouraging step towards finding new treatment methods for Alzheimer’s, there are several other parameters in the rTMS treatment protocol whose investigation is not currently funded. They include: the method by which rTMS pulses are delivered, the location of the stimulation and the duration of treatment. Our current study investigates only the standard protocol of rTMS treatment. We hope after some preliminary results to apply for, and receive, more funding to continue the research.</p>
<p>The number of people affected by Alzheimer’s disease is on the rise. Alzheimer’s not only steals precious aspects of life from affected individuals but also from their families. Alzheimer’s forces the relatives of a patient to hopelessly watch a tragedy progress over a prolonged period of time, day after day. </p>
<p>Alzheimer’s disease is a multifold condition that requires a multidisciplinary approach for its treatment. It is only through our collective efforts that we can hope to find a solution for such a grim and dreadful disease. Despair may fly on the wings of morning; out of the heart of darkness comes the light.</p><img src="https://counter.theconversation.com/content/81886/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Zahra Moussavi receives funding from Weston Brain Institute and Natural Science and Engineering Research Council (NSERC) of Canada merely for research. She works at the University of Manitoba as a professor in Biomedical Engineering. She is affiliated with the Riverview Health Center as a research affiliate. </span></em></p>When Zahra Moussavi's mother developed Alzheimer's, the scientist pursued a technology that directly stimulates the brain with electromagnets to mitigate the effects of the disease. It worked.Zahra Moussavi, Professor of Biomedical Engineering, University of ManitobaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/827012017-08-30T08:22:47Z2017-08-30T08:22:47ZBrain stimulation can boost creativity – but could it also help you hear inspirational voices?<figure><img src="https://images.theconversation.com/files/183773/original/file-20170829-10418-l52jwz.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=496&amp;fit=clip" /><figcaption><span class="caption">Inspiration can come when we least expect it. </span> <span class="attribution"><span class="source">Alena Ozerova/Shutterstock</span></span></figcaption></figure><p>Steve Jobs, the late co-founder of Apple, once said “<a href="https://www.wired.com/1996/02/jobs-2/">creativity is just connecting things</a>”. There’s truth in that but there is another source of creativity, too – the ideas that simply pop into our minds. In ancient times, these were seen as <a href="https://en.wikipedia.org/wiki/Artistic_inspiration">gifts from the muses or gods</a>. Today, people sometimes describe such ideas as coming from an inner voice or even a character separate from themselves.</p>
<p>The creative ability to make connections between things is something neuroscience can improve using a brain stimulation technique called transcranial direct current stimulation (tDCS), which passes a weak electric current through the brain via electrodes on the head. But could the same technique also boost creativity by summoning inner voices?</p>
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<span class="caption">A demonstration of transcranial direct current stimulation.</span>
<span class="attribution"><span class="source">Air Force photo by Bill Hancock</span></span>
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<p>When I experienced tDCS in our research laboratory I merely felt a slight warmth and itch on my scalp. The technique is <a href="http://www.sciencedirect.com/science/article/pii/S2467981X16300233">considered safe</a> and <a href="http://www.sciencedirect.com/science/article/pii/S0361923007000111">adverse effects are relatively minor</a>. Of course, it is not something to be attempted at home.</p>
<p>It works by temporarily increasing the activity of the part of the brain under the positive electrode, decreasing it under the negative electrode, and altering connectivity within the brain. It has been used for a range of purposes, from boosting performance in <a href="http://www.sciencedirect.com/science/article/pii/S1053811912011743">Air Force personnel</a> to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4799388/">treating psychiatric disorders</a>.</p>
<p>Researchers have also discovered it can increase creativity. A <a href="https://academic.oup.com/cercor/article/27/4/2628/3056344/Thinking-Cap-Plus-Thinking-Zap-tDCS-of-Frontopolar">recent study</a> found it allowed people to make more “outside of the box” connections. This study placed the positive electrode over the left frontopolar cortex, which is involved in processes including <a href="http://www.pnas.org/content/112/9/E1020.full">multitasking, reasoning and memory</a>. Participants who experienced tDCS were able to make more creative analogies.</p>
<p>But what about the experience of ideas that just pop up? Waiting for ideas to come is unnerving, as we come to realise we have little or no control over this process. As the stand-up comedian <a href="https://www.theguardian.com/culture/2015/jan/04/stewart-lee-i-dont-know-where-the-ideas-come-from">Stewart Lee puts it</a>:</p>
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<p>I don’t know where the ideas come from, and it’s terrifying. They seem to be absolute flukes … I’m just hoping that some sort of event will descend on me.</p>
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<p>Many writers have information descend on them from their characters, who can be experienced as <a href="http://journals.sagepub.com/doi/abs/10.2190/FTG3-Q9T0-7U26-5Q5X?journalCode=icaa">autonomous entities</a> that communicate with them. Writer <a href="http://www.bfi.org.uk/films-tv-people/4ce2b8bd16267">Hilary Mantel describes</a> the creation of her story, The Giant, O'Brien as “it being listened to by me”. She asks:</p>
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<p>How can I seem to produce a character who acts in a way that is independent from me and foreign to me? Where did these thoughts come from?</p>
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<p>Author <a href="https://dianerehm.org/shows/2016-12-29/j-k-rowling-rebroadcast">JK Rowling reports</a> some of her characters come through a “mysterious process no one really understands”, just popping up.</p>
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<span class="caption">JK Rowling says some of her characters ‘just pop up’.</span>
<span class="attribution"><span class="source">s_bukley/Shutterstock</span></span>
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<p>Could we use neurostimulation to facilitate this mysterious process? Could we even summon an artificial muse? To answer this, we need to consider people who already have them.</p>
<h2>The science of inner voices</h2>
<p>A common way to experience others in our heads is through “hearing voices”. <a href="http://journals.sagepub.com/doi/abs/10.2190/74V5-HNXN-JEY5-DG7W?journalCode=icaa">Most of us</a> have had fleeting such experiences, like hearing our name called when no one is there. <a href="http://www.jkp.com/uk/can-t-you-hear-them-34840.html">Around 2-3% of the population</a> have more extended voice-hearing experiences. </p>
<p>If the voice is nasty <a href="https://www.ncbi.nlm.nih.gov/pubmed/21450152">this can cause problems</a> and lead the person to seek help. If, however, the voice is friendly or benign, and the person <a href="https://www.ncbi.nlm.nih.gov/pubmed/28053132">has some control over it</a>, they may <a href="https://www.ncbi.nlm.nih.gov/pubmed/27866082">never need or seek help</a>. </p>
<p>Some voices are <a href="https://www.ncbi.nlm.nih.gov/pubmed/23267192">simply gibberish</a>. Others say the same kind of thing over and over, like a stuck record. Some are like memories, recapitulating the past. But others have more creative potential.</p>
<p>The French mathematician Françoise Chatelin <a href="http://www.bfi.org.uk/films-tv-people/4ce2b8bd16267">described how</a> hearing voices helped her “open a new door on the way to perceive numbers”. The English psychologist <a href="https://www.ted.com/talks/eleanor_longden_the_voices_in_my_head">Eleanor Longden revealed how</a>, when she was a student, voices told her answers during exams. Another English voice-hearer, Peter Bullimore, wrote a book using ideas and characters his voices gave him and says he “<a href="https://mentalhealthrecovery.omeka.net/exhibits/show/peter-bullimore/hearing-voices/a-village-called-pumpkin">couldn’t have done it without them</a>”. </p>
<p>Research shows tDCS can <a href="https://www.ncbi.nlm.nih.gov/pubmed/25798123">reduce voice-hearing</a> in people diagnosed with schizophrenia, which is <a href="http://journals.sagepub.com/doi/full/10.1177/1049732315581602">what some want</a>. Such studies typically increase the activity of the left prefrontal cortex, involved in planning and controlling our thoughts and actions, reduce activity in the left temporoparietal junction, involved in <a href="https://www.ncbi.nlm.nih.gov/pubmed/16460715">communicating with others</a>, and <a href="https://www.ncbi.nlm.nih.gov/pubmed/26303936">alter the connectivity between the frontal and temporal lobes of the brain</a>.</p>
<p>So, what would happen if we performed this <em>in reverse</em> – in people who don’t hear voices? A recent study, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4179889/">published in the journal Neuropsychologia</a>, did something similar to this with healthy volunteers and found it caused them to be more likely to hallucinate words in white noise. <a href="http://www.nature.com/nature/journal/v443/n7109/full/443287a.html?foxtrotcallback=true">Other studies</a> have found neurostimulation of the left temporoparietal junction causes the feeling that an unseen person is near.</p>
<p>We are clearly a long way from an electric muse. Yet such research places it on the horizon. We would also need a cultural shift for this idea to be adopted – a move from viewing voice-hearing as <a href="http://journals.sagepub.com/doi/abs/10.1177/0020764014535757">necessarily a sign of pathology</a> to one which accepts it can sometimes be <a href="http://www.pccs-books.co.uk/products/living-with-voices-50-stories-of-recovery#.WZgPnT6GOpo">helpful, creative and desirable</a>.</p>
<h2>Beyond neuroscience</h2>
<p>Of course, other approaches can also push our brain to speak to us. “Sensory deprivation” – blocking a specific sense through, for example, blindfolds or earmuffs – has <a href="https://link.springer.com/article/10.1007/s11097-011-9233-z">some limited ability</a> to summon voices. Absorptive practices <a href="http://www.penguinrandomhouse.com/books/104442/when-god-talks-back-by-t-m-luhrmann/9780307277275/">such as prayer or meditation</a> can also cause voice-hearing. Indeed, practitioners of <a href="https://www.vice.com/en_us/article/exmqzz/tulpamancy-internet-subculture-892">Tulpamancy</a> claim to conjure up seemingly <a href="http://somatosphere.net/2015/04/varieties-of-tulpa-experiences-sentient-imaginary-friends-embodied-joint-attention-and-hypnotic-sociality-in-a-wired-world.html">sentient entities</a> through meditation.</p>
<p>A simpler, although obviously illegal, route are psychedelic drugs such as <a href="http://www.simonandschuster.com/books/DMT-The-Spirit-Molecule/Rick-Strassman/9780892819270">DMT</a> and <a href="http://psycnet.apa.org/record/2005-09713-005">psilocybin</a>. As Terence McKenna once said of psilocybin, “<a href="https://www.youtube.com/watch?v=KfgRWZx7Q00">there is a mind there waiting</a>”. Unfortunately, there are few formal studies of <a href="http://www.ingentaconnect.com/content/ben/cdar/2014/00000007/00000002/art00006">what these encounters are like</a> and <a href="https://academic.oup.com/schizophreniabulletin/article/39/6/1343/1883760/Functional-Connectivity-Measures-After-Psilocybin">how the brain creates them</a>. Such research could tell us much about what our brains are capable of, and how.</p>
<p>Even if it were feasible to use neurostimulation to conjure ideas via voices, would it be ethical? Lacking control of voices and not liking what they said could <a href="https://www.ncbi.nlm.nih.gov/pubmed/21450152">lead to distress and problems functioning</a>. Voices could also be dangerously deified rather than critically considered, as the unseen are often <a href="https://www.ncbi.nlm.nih.gov/pubmed/22115329">mistaken for the unerring</a>.</p>
<p>Also, what would we have created – philosophically speaking? Could it exhibit intelligent human behaviour? Would it display self-conscious emotions, or even be conscious? This would be what many writers strive for. Indeed, Hilary Mantel describes the writing process as “<a href="http://www.bfi.org.uk/films-tv-people/4ce2b8bd16267">allowing a new consciousness to emerge</a>”. </p>
<p>New understandings of the brain will, eventually, help us tap our inner wells for inspiration. This process may even shed light on how consciousness arises. As inventor Thomas Edison noted, though, it will only be through a lot of perspiration that such inspiration gets us anywhere.</p><img src="https://counter.theconversation.com/content/82701/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr McCarthy-Jones receives research funding from the Irish Research Council and the US-based Brain &amp; Behavior Research Foundation.</span></em></p>Many writers say they have inspiration come to them from their characters or an inner voice. Science is seeking answers.Simon McCarthy-Jones, Associate Professor in Clinical Psychology and Neuropsychology, Trinity College DublinLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/775842017-05-16T00:58:02Z2017-05-16T00:58:02ZElectrically stimulating your brain can boost memory – but here's one reason it doesn't always work<figure><img src="https://images.theconversation.com/files/169165/original/file-20170512-3682-f4tcye.jpg?ixlib=rb-1.1.0&amp;rect=290%2C0%2C2350%2C1765&amp;q=45&amp;auto=format&amp;w=496&amp;fit=clip" /><figcaption><span class="caption">Is electrical pulse to the brain your favorite memory enhancer?</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/airmanmagazine/33376636056">U.S. Air Force photo by J.M. Eddins Jr.</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><p>The first time I heard that shooting electrical currents across your brain can boost learning, I thought it was a joke.</p>
<p>But evidence is mounting. According to a handful of studies, transcranial direct current stimulation (tDCS), the poster child of brain stimulation, is a bona fide cognitive booster: By directly tinkering with the brain’s electrical field, some research has found that tDCS <a href="https://doi.org/10.1016/j.neulet.2012.03.012">enhances creativity</a>, bolsters <a href="https://doi.org/10.1007/s00221-014-4022-x">spatial</a> and <a href="https://dx.doi.org/10.1016/j.cub.2013.04.045">math learning</a> and even <a href="https://doi.org/10.1162/jocn.2008.20098">language aquisition</a> – sometimes <a href="https://dx.doi.org/10.1016/j.cub.2013.04.045">weeks after the initial zap</a>. </p>
<p>For those eager to give their own brains a boost, this is good news. <a href="https://www.reddit.com/r/tDCS/">Various communities</a> have sprung up to share tips and tricks on how to test the technique on themselves, often using self-rigged stimulators powered by 9-volt batteries. </p>
<p>Scientists and brain enthusiasts aren’t the only people interested. The military has also been <a href="https://www.defense.gov/News/Article/Article/1164793/darpa-funds-brain-stimulation-research-to-speed-learning/">eager to support</a> projects involving brain stimulation with the hope that the technology could one day be used to help soldiers suffering from combat-induced memory loss.</p>
<p>But here’s the catch: The end results are inconsistent at best. While some people swear by the positive effects anecdotally, others report nothing but <a href="https://doi.org/10.1016/j.brs.2014.10.015">a nasty scalp burn</a> from the electrodes.</p>
<p>In a <a href="https://dx.doi.org/10.1016/j.brs.2015.01.400">meta-analysis covering over 20 studies</a>, a team from Australia found no significant effects of tDCS on memory. Similar disparities pop up for <a href="https://dx.doi.org/10.1016/j.neuroimage.2013.06.007">other brain stimulation techniques</a>. It’s not that brain stimulation isn’t doing anything – it just doesn’t seem to be doing something consistently across a diverse population. So what gives? </p>
<p>It looks like timing is everything. </p>
<h2>When the zap comes is crucial</h2>
<p>We all have good days when your brain feels sharp and bad days when the “brain fog” never lifts. This led scientists to wonder: Because electrical stimulation directly regulates the activity of the brain’s neural networks, what if it gives them a boost when they’re faltering, but conversely disrupts their activity when already performing at peak? </p>
<p>In <a href="https://doi.org/10.1016/j.cub.2017.03.028">a new study</a> published in “Current Biology,” researchers tested the idea using the most direct type of brain stimulation – electrodes implanted into the brain. Compared to tDCS, which delivers currents through electrodes on the scalp, implanted ones allow much higher precision in controlling which brain region to target and when.</p>
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<span class="caption">Blue dots indicate overall electrode placement in the new study from the University of Pennsylvania; the yellow dot (top-right corner) is the electrode used to stimulate the subject’s brain to increase memory performance.</span>
<span class="attribution"><a class="source" href="https://news.upenn.edu/news/penn-researchers-show-brain-stimulation-restores-memory-during-lapses">Joel Stein and Youssef Ezzyat</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<p>The team collaborated with a precious resource: epilepsy patients who already have electrodes implanted into their hippocampi and surrounding areas. These brain regions are crucial for memories about sequences, spaces and life events. The electrodes serve a double purpose: They both record brain activity and deliver electrical pulses. </p>
<p>The researchers monitored the overall brain activity of 102 epilepsy patients as they memorized 25 lists of a dozen unrelated words and tried to recall them later on.</p>
<p>For each word, the researchers used the corresponding brain activity pattern to train a type of software called a classifier. In this way, for each patient the classifier eventually learned what types of brain activity preceded successfully remembering a word, and what predicted failed recall. Using this method, the scientist objectively classified a “foggy” brain state as the pattern of brain activity that preceded an inability to remember the word, while the pattern of activity common before successfully recalling is characteristic of being on the ball.</p>
<p>Next, in the quarter of patients for whom the classifier performed above chance, the researchers zapped their brains as they memorized and recalled a new list of words. As a control, they also measured memory performance without any stimulation, and the patients were asked whether they could tell when the electrodes were on (they couldn’t). </p>
<p>Here’s what they found: when the zap came before a low, foggy brain state, the patients scored roughly 12 to 13 percent higher than usual on the recall task. But if they were already in a high-performance state, quite the opposite occurred. Then the electrical pulse impaired performance by 15 to 20 percent and disrupted the brain’s encoding activity – that is, actually making memories.</p>
<h2>Moving beyond random stimulation</h2>
<p>This study is notably different from those before. Rather than indiscriminately zapping the brain, the researchers showed that the brain state at the time of memory encoding determines whether brain stimulation helps or hinders. It’s an invaluable insight for future studies that try to tease apart the effects of brain stimulation on memory.</p>
<p>The next big challenge is to incorporate these findings into brain stimulation trials, preferably using noninvasive technologies. The finding that brain activity can predict recall is promising and builds upon previous research <a href="https://doi.org/10.1523/JNEUROSCI.4039-12.2013">linking brain states to successful learning</a>. These studies may be leveraged to help design “smart” brain stimulators. </p>
<p>For example: Picture a closed-loop system, where a cap embedded with electrodes measures brain activity using EEG or other methods. Then the data go to a control box to determine the brain state. When the controller detects a low functioning state, it signals the tDCS or other stimulator to give a well-timed zap, thus boosting learning without explicit input from the user.</p>
<p>Of course, many questions remain before such a stimulator becomes reality. What are the optimal number and strength of electrical pulses that best bolster learning? Where should we place the electrodes for best effect? And what about unintended consequences? A previous study found that boosting learning may actually <a href="https://doi.org/10.1523/JNEUROSCI.4927-12.2013">impair a person’s ability to automate that skill</a> – quickly and effortlessly perform it – later on. What other hidden costs of brain stimulation are we missing?</p>
<p>I’m not sure if I’ll ever be comfortable with the idea of zapping my brain. But this new study and the many others sure to follow give me more confidence: If I do take the leap into electrical memory enhancement, it’ll be based on data, not on anecdotes.</p><img src="https://counter.theconversation.com/content/77584/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Shelly Fan does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Tinkering with the brain's electrical field shows tantalizing promise for boosting memory, but it doesn't always work. A new study offers one reason why.Shelly Fan, Postdoctoral Scholar in Neuroscience, University of California, San FranciscoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/759182017-04-27T20:04:41Z2017-04-27T20:04:41ZWhy brain stimulation isn't what it's cracked up to be<figure><img src="https://images.theconversation.com/files/166782/original/file-20170426-2838-rtgqtu.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=496&amp;fit=clip" /><figcaption><span class="caption">About half of studies of some types of brain stimulation cannot be reproduced. So, how do we know if these work?</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/521251375?src=3ExGRfV8-B3WHzPbsBaQuw-1-7&amp;size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>Interest in <a href="https://en.wikipedia.org/wiki/Transcranial_direct-current_stimulation">electrical brain stimulation</a> has skyrocketed in recent years, both in the <a href="https://theconversation.com/brain-stimulation-offers-hope-for-depression-but-dont-try-it-at-home-31625">popular</a> <a href="https://theconversation.com/brain-stimulation-is-getting-popular-with-gamers-is-it-time-to-regulate-it-66845">media</a> and <a href="http://www.cell.com/neuron/abstract/S0896-6273(14)00389-4">scientific literature</a>. </p>
<p>Scientists and clinicians are using the non-invasive and cheap technique to treat various <a href="http://www.sciencedirect.com/science/article/pii/S1388245716306344">neurological and psychiatric disorders</a>, including depression, epilepsy and addiction. The US military is researching whether it <a href="http://www.bbc.com/future/story/20140603-brain-zapping-the-future-of-war">improves learning and attention</a>. And those who train elite athletes <a href="http://www.nature.com/news/brain-doping-may-improve-athletes-performance-1.19534">can see its potential</a> to enhance performance.</p>
<p>But <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0175635">our research shows</a> the evidence to back electrical brain stimulation varies in quality, and the results are commonly not reproduced in other studies. Our survey also unearthed the lengths to which some researchers go to to present their findings in the best light.</p>
<h2>What is electrical brain stimulation?</h2>
<p>The type of electrical brain stimulation we studied is transcranial direct-current stimulation. This is when a small electric current is applied to the brain for 20 to 30 minutes. Electrodes are placed on the patient’s head, and some of the current passes through the skull to the brain. </p>
<p>It is thought this alters brain function mainly by inducing persistent changes in the excitability of neurones.</p>
<p>This isn’t to be confused with <a href="https://www.beyondblue.org.au/the-facts/depression/treatments-for-depression/medical-treatments-for-depression/electroconvulsive-therapy-(ect)">electroconvulsive therapy</a>, which uses currents hundreds of times larger. This induces a seizure.</p>
<h2>What we did</h2>
<p>We used an online survey to ask researchers if they could reproduce published findings related to electrical brain stimulation. We invited all researchers who served as corresponding authors on a published scientific paper on electrical brain stimulation in humans to do so. </p>
<p>In all, 976 researchers from all over the world were invited to answer the question of whether they could reproduce published electrical brain stimulation effects. </p>
<p>We also asked whether researchers used, but didn’t report, questionable research practices in their own research – such as fiddling with statistics to make them look more favourable and selectively reporting results. And we asked if they thought other researchers used these questionable techniques, and whether they should be reported in publications. </p>
<p>To check what researchers actually do, we audited a random selection of 100 publications featuring research on electrical brain stimulation. We looked to see if they admitted to the dodgy practices in their publications.</p>
<h2>What we found</h2>
<p>For the two most popular types of electrical brain stimulation (anodal and cathodal stimulation), only 45 to 50% of researchers routinely reproduced published findings.</p>
<p>Some researchers were aware of others who handpicked which experimental conditions (36%) and which results (41%) to publish. They also knew researchers who manipulated results by excluding data based on a gut feeling (20%) and fiddling with the statistics (43%).</p>
<p>As expected, fewer researchers admitted to personally using these types of shady research practices. Still, 25% admitted to adjusting statistical analysis to optimise results – namely <a href="https://theconversation.com/how-we-edit-science-part-2-significance-testing-p-hacking-and-peer-review-74547">p-hacking</a>, when researchers manipulate the statistics to make results appear more statistically significant than they might otherwise be.</p>
<p>Our research also revealed the difference between whether these questionable types of practices <em>should be</em> reported in research papers, and whether they <em>are</em>. Although 92% of respondents said all researchers should admit to the questionable practices in their publications, we found only two such admissions (2%) in our audit of published studies.</p>
<h2>So, what do we make of this?</h2>
<p>Meta-analyses, which are studies that pool results from several other studies, indicate electrical brain stimulation is effective in <a href="http://bjp.rcpsych.org/content/208/6/522">major depression</a>. But it isn’t in fibromyalgia (where people experience widespread pain without a known cause), food craving and overeating, Parkinson’s disease, and speech problems after a stroke.</p>
<p>Unfortunately, a general finding is that electrical brain stimulation studies are often of low quality and that, when present, therapeutic effects are often small. So, before you decide to strap electrodes to your head, speak to an informed health professional.</p>
<p>Poor reproducibility and bad science <a href="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020124">are not unique</a> to electrical brain stimulation research. Nor are these problems new. But <a href="https://theconversation.com/we-need-to-talk-about-the-bad-science-being-funded-61916">public funds are being wasted</a> on poorly conducted research that cannot be reproduced, which means the results are questionable. Such poor research is tarnishing the genuine efforts of researchers to improve human brain function.</p>
<p>The main reason researchers engage in questionable researcher practices is the continual pressure to <a href="https://theconversation.com/why-isnt-science-better-look-at-career-incentives-65619">publish scientific papers</a> to gain funding or to progress scientific careers. If results are statistically significant, researchers are <a href="http://science.sciencemag.org/content/345/6200/992">more likely to be published</a>. So, researchers may consciously, or unconsciously, resort to questionable or fraudulent research practices.</p>
<h2>What can we do about it?</h2>
<p>Awareness of bad science is on the rise – and <a href="https://www.nature.com/articles/s41562-016-0021">recommendations</a> and <a href="http://www.acmedsci.ac.uk/policy/policy-projects/reproducibility-and-reliability-of-biomedical-research/">guidelines are emerging</a> to deal with this. But there needs to be more education and true incentives for scientists to conduct better, reproducible science. </p>
<p>If not, some scientists will continue to do as they have always done. Incentives to improve the culture of research include promoting researchers who do more <a href="https://cos.io/">open science</a>, and funding projects that adhere to open science practices as well as those that attempt to replicate studies.</p>
<p>The responsibility to improve the quality of our science lies with research institutions and universities, <a href="http://www.nature.com/news/policy-nih-plans-to-enhance-reproducibility-1.14586">funding agencies</a>, scientific publishers and individual researchers.</p>
<p>Our goal of clinically useful brain stimulation techniques is a worthy one. But our progress is limited by findings of often variable and small effects currently reported, as well as the poor quality of some of the studies that claim any effects at all.</p><img src="https://counter.theconversation.com/content/75918/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Electrical brain stimulation is used to treat a range of conditions, from depression to epilepsy. But how confident can we be that it works?Martin Héroux, Senior Research Fellow, Neuroscience Research AustraliaColleen Loo, Professor of Psychiatry, UNSWSimon Gandevia, Deputy Director, Neuroscience Research AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/719062017-01-25T19:04:57Z2017-01-25T19:04:57ZStimulating the brain with electricity may reduce bulimia symptoms<figure><img src="https://images.theconversation.com/files/154264/original/image-20170125-23854-1r94yy0.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=496&amp;fit=clip" /><figcaption><span class="caption">Bulimia is a debilitating condition.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/girl-stomachache-sitting-on-room-floor-478996522">Shutterstock</a></span></figcaption></figure><p>Key symptoms of bulimia nervosa, including the urge to binge eat, are reduced by delivering electricity to parts of the brain using non-invasive brain stimulation, according to <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0167606">new research</a> conducted by our team at King’s College London.</p>
<p><a href="http://www.nhs.uk/conditions/bulimia/pages/introduction.aspx">Bulimia</a> is an eating disorder characterised by frequent bouts of binge-eating followed by attempts to counteract the increased food intake via self-induced vomiting, extreme dieting, intense exercise, or the misuse of different medicines. These behaviours, which are typically driven by an over-concern with body weight and shape, become increasingly compulsive until they resemble those of an addiction. </p>
<p>Bulimia typically emerges in adolescence and is much more likely to develop in women, with around one to two percent developing the disorder at some stage in their lives. It is associated with multiple medical complications and up to four percent of sufferers die prematurely from the condition. While existing psychological therapies are effective for many people with bulimia, they do not work for a sizeable proportion of patients, so there is a pressing need for new treatments. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2759684/">Evidence shows</a> that bulimia is associated with altered functioning in certain brain pathways, such as those underlying self-control processes. It may be possible to normalise these pathways using modern neuroscience technologies like transcranial direct current stimulation (tDCS). </p>
<p>tDCS is a non-invasive brain stimulation technique which delivers weak electrical currents to the brain through two electrodes placed on the head. It is safe and painless, and the most common side effect is a slight itching or tingling sensation on the scalp. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/154249/original/image-20170125-23854-1ypzch0.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=1000&amp;fit=clip"><img alt="" src="https://images.theconversation.com/files/154249/original/image-20170125-23854-1ypzch0.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=237&amp;fit=clip"></a>
<figcaption>
<span class="caption">Dr Maria Kekic carrying out transcranial direct current stimulation on a volunteer.</span>
<span class="attribution"><span class="source">Dr Maria Kekic</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>For our research, we investigated the short-term effects of tDCS in people with bulimia. Thirty nine volunteers with the disorder received 20 minutes of real tDCS and 20 minutes of placebo tDCS on two separate days at least 48 hours apart (they were unaware of which session was which). The stimulation was administered to a frontal area of the brain involved in self-control. Volunteers completed several questionnaires before and after each session, which measured their urge to binge eat and several other eating disorder symptoms, such as their fear of weight gain and self-esteem difficulties. </p>
<h2>Symptoms reduced</h2>
<p>Our results showed that these bulimia symptoms were significantly reduced by the real tDCS but not by the placebo tDCS. For example, baseline scores on the urge to binge eat scale decreased by 31 percent following real tDCS.</p>
<p>We also measured self-control before and after each tDCS session using a decision-making task involving choices about hypothetical sums of money. For each choice, volunteers had to pick between a smaller amount of money available immediately and a larger amount available in three months. </p>
<p>We found that the real but not the placebo tDCS made people more willing to wait for the larger, delayed sums of money. This reflects more sensible decision-making and better self-control. </p>
<p>Our study suggests that tDCS may suppress the urge to binge eat and reduce the severity of other symptoms in people with bulimia, at least temporarily. We think it does this by improving self-control. Although these are modest, early findings, with a larger sample and multiple sessions of tDCS over a longer period of time, it is likely that the effects would be even stronger. This is something we’re now looking to explore in future studies. </p>
<p>The advantage of tDCS is that it’s much less expensive and more portable than other brain stimulation techniques, which raises the possibility of one day offering treatment that could be self-administered at home by patients with bulimia. This could either be as an addition to existing psychological therapies or as a standalone, alternative approach.</p><img src="https://counter.theconversation.com/content/71906/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This study was funded by an Institute of Psychiatry, Psychology &amp; Neuroscience/Medical Research Council Excellence studentship awarded to Maria Kekic.</span></em></p>Can new ways of using electric currents to stimulate the brain help reduce symptoms of one of the most debilitating eating disorders?Maria Kekic, Researcher, King's College LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/678582016-11-06T20:26:01Z2016-11-06T20:26:01ZInformation before regulation to make amateur brain stimulation safer<figure><img src="https://images.theconversation.com/files/144320/original/image-20161103-25353-t3eb2r.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=496&amp;fit=clip" /><figcaption><span class="caption">Talk to users of electronic brain stimulation.</span> <span class="attribution"><span class="source">Shutterstock OH studio image gallery</span></span></figcaption></figure><p>In the comfort of their own home, an unknown number of people are electrically stimulating their brains.</p>
<p>People are doing it because they believe it can boost mental agility, help with disorders such as depression, or just for the pleasure of exploring a scientific frontier outside the constraints of professional science.</p>
<p>And apparently some computer <a href="https://theconversation.com/brain-stimulation-is-getting-popular-with-gamers-is-it-time-to-regulate-it-66845">gamers are doing it</a> because they think it can improve their performance.</p>
<p>But <a href="https://www.eurekalert.org/pub_releases/2016-07/bidm-nwa070816.php">home brain stimulation is opposed</a> by most neuroscientists on safety grounds. That has helped create a knowledge vacuum that leaves brain stimulation enthusiasts piecing together information on which devices to purchase, and how to use them, from whatever online sources they can find, most often from other home users.</p>
<p>It’s the Wild West of neuroscience. And that needs to change.</p>
<h2>Methods of stimulation</h2>
<p>Whether home users <a href="https://cosmosmagazine.com/biology/buzz-around-brain-stimulation">get the brain boost they seek</a> is unclear. One technique, TMS or transcranial magnetic stimulation, is approved by the US Food and Drug Administration for clinical treatment of <a href="http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm378608.htm">migrane headaches</a> and <a href="http://www.apa.org/monitor/2015/02/magnets.aspx">severe depression</a>. Large trials are also planned for autism, schizophrenia and stroke.</p>
<p>But the jury is out on the go-to technique for home use which is tDCS, or transcranial direct-current stimulation. Lab tests suggest that tDCS changes language and maths abilities, attention, video gaming ability (part of its popular appeal) and other cognitive skills, but more evidence is needed to be sure.</p>
<p>And here’s the rub. If electrical stimulation does boost brain function, it can also harm it. That’s why brain researchers are careful to limit risk by being conservative about how long and how often they stimulate someone’s brain. Home users won’t be so cautious, especially without access to information.</p>
<p>The research community’s response to home use is to draw attention in carefully-couched terms to its dangers, still largely unknown but generally considered likely to be slight, such as in this <a href="http://onlinelibrary.wiley.com/doi/10.1002/ana.24689/full">open letter in the Annals of Neurology</a>.</p>
<p>Or researchers’ reaction is to <a href="https://theconversation.com/brain-stimulation-is-getting-popular-with-gamers-is-it-time-to-regulate-it-66845">ask for more regulation</a>.</p>
<h2>Regulations</h2>
<p>Consumer brain stimulation devices, which can be legally purchased online, are already regulated by the general consumer rules set out by the <a href="https://www.accc.gov.au/consumers/consumer-protection/buying-safe-products">Australian Competition and Consumer Commission</a> and in the US by the <a href="https://www.accc.gov.au/consumers/consumer-protection/buying-safe-products">Consumer Product Safety Commission</a>.</p>
<p>But overzealous regulation has the potential to do harm as well as prevent it. It could, for example, slow the development of these devices to treat mental health disorders, an area in which there is a pressing need for effective therapies and where brain stimulation shows much promise.</p>
<p>The consumer market for brain stimulation devices provides an opportunity to optimise design. John Reppas, director of public policy at the Neurotechnology Industry Association, told the US Food and Drug Administration meeting <a href="http://www.fda.gov/downloads/MedicalDevices/NewsEvents/WorkshopsConferences/UCM480906.pdf">Noninvasive Neurostimulation Devices and Cognitive Function</a> last year:</p>
<blockquote>
<p>It [may also] allows an eventual next-generation medical grade product to be developed and financed a lot more quickly […]</p>
</blockquote>
<p>Then there’s the case for personal autonomy. Allowing adults to learn more about their own bodies and brains, even to alter their function, is not necessarily bad. We allow adults to change body and brain function with caffeine, alcohol, exercise, and learning. Is the use of electrical brain stimulation devices different?</p>
<h2>Talk to the users</h2>
<p>We suggest a more pragmatic approach to harm reduction. Don’t stop with just a warning to home users, or calls for greater regulation.</p>
<p>Why not also work with home users to understand what drives them, to test the devices they use, and fill the information void with scientist-sanctioned safety guidelines and easily-accessible translations of new findings. These would include the limitations and side-effects.</p>
<p>Nick Davis, a neuroscientist at Manchester Metropolitan University, <a href="http://jlb.oxfordjournals.org/content/early/2016/04/05/jlb.lsw013.full">goes further</a> to suggest harnessing this “pool of creative and engaged self-experimenters [to] shape and inform the future uses of tDCS”.</p>
<p>Health agencies could also step in with a similar approach to that taken to <a href="https://theconversation.com/stem-cell-tourism-exploits-people-by-marketing-hope-29146">stem cell tourism</a>, in which people with life-limiting illnesses travel overseas for what are often unproven therapies. </p>
<p>Stem cell tourism and lounge room brain stimulation share similarities. In both cases, users have moved a new technology out of the lab before the evidence is in.</p>
<p>Both technologies promise game-changing treatments for intractable health problems, firing a scientific optimism that has gushed into public consciousness, driving demand for an under-developed technology.</p>
<p>When first faced with stem cell tourism, scientists tended to protest its foolishness. But after listening more carefully to the tourists to understand what was driving them (in a nutshell, no other options), some changed tack.</p>
<p>They brought together stem cell scientists, people who wanted the technology in its unbaked state, and those who wanted it developed and approved first. They talked through issues of <a href="http://www.palgrave.com/la/book/9781137470423">safety, evidence, autonomy and hope</a>.</p>
<p>Their efforts culminated in advice from various bodies, including the National Health and Medical Research Council <a href="https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/rm001a_stem_cell_treatments_faq_131220.pdf">providing information</a>, to assist people contemplating stem cell tourism. Why not a similar approach to the lounge room use of brain stimulation devices?</p>
<p>Brain stimulation is cheap, accessible and potentially of interest to anyone who ever wished they could think faster, or at least better than their colleagues, their ageing self, their class mates or their competitors.</p>
<p>Nobody knows how many people currently home use, or who they are. Recreational gamers are clearly not the whole story. We know of people who home use in attempts to treat age-related cognitive decline and severe, uncontrolled mental disorders.</p>
<p>What we do know is that if the brain stimulation makes good on its early promise those numbers will surely grow, never mind how many cautious warnings and calls for greater regulation are issued.</p>
<hr>
<p><em>Peter Simpson-Young, who is a masters student of health technology innovation at University of Sydney, was a co-author on this article. He has used brain stimulation at home.</em></p><img src="https://counter.theconversation.com/content/67858/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rachel Nowak is director of The Brain Dialogue, an initiative of the Australian Research Council Centre of Excellence for Integrative Brain Function. She is also principal at Rachel Nowak and Associates, a consultancy working to connect universities, industry, and society. </span></em></p>People who electrically stimulate their brains at home need more information to do it safely... and neuroscience needs to find out more about how and why they do it.Rachel Nowak, Director, The Brain Dialogue, ARC Centre of Excellence for Integrative Brain Function, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/668452016-10-16T19:07:47Z2016-10-16T19:07:47ZBrain stimulation is getting popular with gamers – is it time to regulate it?<figure><img src="https://images.theconversation.com/files/141744/original/image-20161014-3982-pjg73g.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=496&amp;fit=clip" /><figcaption><span class="caption">Think hard before taking it to the next level.</span> <span class="attribution"><span class="source">ymgerman/Shutterstock.com</span></span></figcaption></figure><p>Gamers are increasingly turning to brain stimulation devices to enhance their performance. Using small, gentle electrical currents sent between two or more electrodes placed on a person’s head, these transcranial direct current stimulation (tDCS) devices manipulate brain cells’ activity. </p>
<p>But there is little regulation governing the safety and effectiveness of these devices, particularly for users who are at greater risk, such as children or those with existing mental health problems.</p>
<p>The low current issued by a tDCS device is not enough to cause brain cells to fire, but it <a href="http://www.maprc.org.au/brain-stimulation-treatment-trials">changes their readiness to fire</a>. This has been shown to <a href="http://jlb.oxfordjournals.org/content/1/1/68.short">enhance memory, attention, language and mathematics skills</a>. In medical terms, tDCS is being trialled for the treatment of chronic pain, epilepsy, stroke, Parkinson’s disease and depression. </p>
<p>These devices are also being <a href="https://thebrainstimulator.net/">marketed to DIY gamers</a>, with <a href="http://jlb.oxfordjournals.org/content/early/2015/06/01/jlb.lsv017.full">enthusiastic take-up</a>. For many gamers, these products are seen as the most advanced tool available for <a href="https://speakwisdom.wordpress.com/tag/focus-headset-review/">enhancing their performance</a>. But despite the marketing hype, evidence of the effectiveness of commercial tDCS devices in the gaming environment is not clear. </p>
<h2>Safety and side effects</h2>
<p>Beyond a potential lack of effectiveness, there are some very real safety concerns that should be taken into account regarding their use by DIY gamers.</p>
<p>While tDCS has been shown to be <a href="http://www.sciencedirect.com/science/article/pii/S1388245715010883">relatively safe</a>,
there can be unwanted and unexpected <a href="http://www.bbc.com/news/health-27343047">side effects</a> if used incorrectly. These can include skin burns from electrode attachment, seizures and mood swings, increased anger, prolonged impairment to thinking and <a href="http://www.fiercebiotech.com/medical-devices/study-finds-electrical-brain-stimulation-impairs-memory">memory</a>, a <a href="https://theconversation.com/brain-stimulation-offers-hope-for-depression-but-dont-try-it-at-home-31625">worsening of pre-existing depression</a>, and increased problems with cardiovascular and neural function.</p>
<p>Identifying the risks involved in using these products is difficult because long-term consumer safety studies have not been done. But what is known necessitates a precautionary approach.</p>
<h2>Differing effects</h2>
<p>The type of brain stimulation required to give a positive effect may differ depending on a person’s individual mental health and brain anatomy. Brain stimulation that improves one person’s functioning might not be the same for someone else, so a “one-size-fits-all” approach is problematic.</p>
<p>This is particularly true of children, whose brains are still developing. The skulls of younger people are also thinner, meaning that the stimulation applied to a child’s brain could potentially have a <a href="http://jlb.oxfordjournals.org/content/early/2016/04/05/jlb.lsw013.full">much greater adverse effect</a> than the same amount and frequency delivered to a fully developed adult brain. This may be particularly troubling in the case of <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3058-1">tDCS devices used by young gamers, and those with psychiatric conditions such as attention-deficit hyperactivity disorder (ADHD)</a>.</p>
<h2>Time to regulate?</h2>
<p>Given concerns over how they might impact vulnerable groups in the long term, it is time to consider whether consumer tDCS devices should be regulated. If such products were to be regulated, they would likely come under <a href="http://www.austlii.edu.au/au/legis/cth/consol_act/tga1989191/">medical device regulation</a>.</p>
<p>The Australian regulator, the Therapeutic Goods Administration (TGA), would need to be satisfied that these products are “medical devices”, <a href="http://www.austlii.edu.au/au/legis/cth/consol_act/tga1989191/s41bd.html">defined</a> as devices used in “preventing, diagnosing, curing or alleviating a disease, ailment, defect or injury” or “modifying … a physiological process”.</p>
<p>Whether or not to bring such products within medical device regulation is currently a matter for debate in both <a href="http://www.oxfordmartin.ox.ac.uk/downloads/briefings/Mind_Machines.pdf">Europe</a> and the <a href="https://jlb.oxfordjournals.org/content/3/2/318.full">United States</a>. Manufacturers of consumer tDCS products have made claims about general wellness and cognitive enhancement, such as increased attention. Arguably, this latter claim could imply suitability for the treatment of conditions where this is a clinical condition, such as ADHD, making it feasible to bring it within medical device regulation.</p>
<p>The US regulator, the Food and Drug Administration (FDA), has taken the lead in the area, last year convening a <a href="http://www.fda.gov/MedicalDevices/NewsEvents/WorkshopsConferences/ucm458018.htm">public workshop</a> to explore how best to approach the issue. The FDA also made clear in a <a href="http://www.fda.gov/downloads/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/UCM429674.pdf">set of guidelines published in July</a> on general wellness products that it does not consider “a neurostimulation product that claims to improve memory” to be low-risk, “due to the risks to a user’s safety from electrical stimulation”.</p>
<p>tDCS devices have been shown to be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3270156/">relatively safe when used by trained clinicians in healthy individuals</a>. However, there are known side effects, ranging from minor to significant, leading to potential risks for DIY users. These devices are largely under-regulated compared with other neurological interventions. </p>
<p>Following the lead of the FDA, the Australian regulator (TGA) should take steps to examine the safety risks involved in using these devices. This is especially important for vulnerable groups, such as young gamers, given their potential to significant impact the brain.</p><img src="https://counter.theconversation.com/content/66845/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adrian Carter receives funding from the Australian Research Council.
</span></em></p><p class="fine-print"><em><span>Anne-Maree Farrell receives funding from the Australian Research Council.</span></em></p><p class="fine-print"><em><span>Naomi Burstyner does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Brain stimulating headsets are being enthusiastically taken up by gamers aiming to boost performance. But there are risks, particularly for children or those vulnerable to mental health problems.Naomi Burstyner, Senior Fellow, La Trobe UniversityAdrian Carter, Senior Research Fellow, Monash UniversityAnne-Maree Farrell, Professor, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/316252014-12-03T19:33:24Z2014-12-03T19:33:24ZBrain stimulation offers hope for depression, but don't try it at home<figure><img src="https://images.theconversation.com/files/66131/original/image-20141203-17733-1fviiqc.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=496&amp;fit=clip" /><figcaption><span class="caption">For people with severe depression, incorrect application can worsen their condition or cause memory loss.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/nathanoliverphotography/6637122727">Nathan O&#39;Nions/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><p>Around <a href="http://www.who.int/mental_health/management/depression/who_paper_depression_wfmh_2012.pdf">350 million people</a> worldwide have depression. Antidepressant medications are often prescribed to treat the condition, alongside talking therapies and lifestyle changes such as regular exercise. </p>
<p>But a substantial proportion of people either don’t respond to antidepressants, or experience such significant side effects that they’d prefer not to take them.</p>
<p>In search of alternative solutions, researchers around the world, including our team, are investigating transcranial direct current stimulation (TDCS) as an alternative treatment for depression. But this isn’t something you can safely try at home.</p>
<p>Unlike <a href="https://theconversation.com/its-time-to-move-on-from-ects-shocking-past-3312">electroconvulsive therapy</a>, TDCS uses very mild electric current to stimulate the brain and has few side effects. The mechanics of TDCS are quite simple, involving a battery, two leads and the electrodes through which the current is passed. </p>
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<span class="caption">Researchers are yet to fully understand the effects of varying stimulation approaches.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-213577552/stock-photo-electromyography.html?src=pp-same_artist-213577561-X3bDsDjQdzafR7GUOK2QMw-5">Tinydevil/Shutterstock</a></span>
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<p>The stimulation works by changing the activity of nerve cells in the brain. In depression, the left frontal areas of the brain are often less active than usual. TDCS stimulates this area to restore brain activity. </p>
<p>We’re still evaluating the effectiveness of TDCS, but so far <a href="http://www.ncbi.nlm.nih.gov/pubmed/22236735">studies</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/22215866">have</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/23389323">found</a> that TDCS works better than a placebo (or simulated treatment) at reducing symptoms of depression. </p>
<p>When combined with the antidepressant medication sertraline (marketed as Zoloft in Australia), the combination TDCS-drug therapy works better than medication or TDCS alone. </p>
<p>Research has found that among people with depression, a course of TDCS can <a href="http://www.ncbi.nlm.nih.gov/pubmed/24968188">improve the brain’s “neuroplasticity”</a>, which is the brain’s ability to learn and adapt to changes in the environment. </p>
<p>The therapy has a good safety profile – if administered by clinicians and researchers trained in stimulation technique and safety. Our research team has administered thousands of TDCS sessions without incident. </p>
<p>But this is not the case when TDCS is used in the “DIY” context, with DIY users trying to stimulate their own brains. </p>
<p>This phenomenon is often guided by online forums and websites dedicated to DIY TDCS. Users comment on their own experience and share tips on how TDCS can be used to treat their own depression. People with no medical training and limited understanding of TDCS self-treat their depression and advise others on treatment.</p>
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<span class="caption">Stronger is not necessarily better.</span>
<span class="attribution"><a class="source" href="https://creativecommons.org/licenses/by-nc-sa/2.0/">Ian Ruotsala/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
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<p>So, what can go wrong? </p>
<p>The most obvious concern is that poor technique and improper electrode placement could cause skin burns. </p>
<p>What’s more concerning is the ability for TDCS to produce lasting changes in brain functioning. Depending on how TDCS is given, these changes could be good or bad. </p>
<p>A DIY user could, for example, cause lasting impairment to their thinking and memory. For people with severe depression, incorrect application could worsen their condition or induce a <a href="http://www.ncbi.nlm.nih.gov/pubmed/19483641">hypomanic</a> (manic) episode. </p>
<p>When it comes to medications, it’s important to get the right dose and dosing schedule. That’s why this role falls to qualified clinicians and researchers. The same goes for TDCS: current intensity, electrode size and position, and the duration and frequency of the stimulation determine the effects in the brain. </p>
<p>The <a href="http://www.ncbi.nlm.nih.gov/pubmed/23339180">relationship</a> between dosing, intensity and position <a href="http://www.ncbi.nlm.nih.gov/pubmed/23664681">is highly</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/23991076">complex</a>. This isn’t a simple case of “the stronger the better”. Even researchers are yet to fully understand the effects of varying stimulation approaches and much more research is needed. </p>
<p>As with other forms of treatment, TDCS is not suitable for everyone. In clinical research trials, participants are screened for suitability to receive stimulation and their likelihood of responding to treatment. The stimulation is carefully controlled and the participants’ mood is carefully monitored during and after the course of treatment. </p>
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<span class="caption">A substantial proportion of people don’t respond to antidepressants, or experience significant side effects.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/divine_harvester/5711349621">Divine Harvester/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
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<p>TDCS represents a promising future, where simple and cost-effective treatment for depression is possible, without drugs. Researchers worldwide are continuing to study this experimental treatment, which may one day become a conventional treatment for depression. </p>
<p>The acceptance and popularity of TDCS among the general community is encouraging. But TDCS is still experimental and isn’t safe to administer at home. DIY users are not trained in proper technique nor are they trained to identify, prevent or deal with unexpected outcomes. </p>
<p><em>If you’re interested in participating in our TDCS trials for depression, contact the research team at the <a href="http://www.blackdoginstitute.org.au/public/research/participateinourresearch/directcurrentstimulationdcs.cfm">Black Dog Institute</a> for more information.</em></p><img src="https://counter.theconversation.com/content/31625/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Colleen Loo has received a competitive research grant from the Stanley Medical Research Foundation for tDCS research in depression and a research grant from the Australian Health and Medical Research Council to conduct a clinical trial of tRNS, a related technology, in depression.</span></em></p><p class="fine-print"><em><span>Kerrie-Anne Ho does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Around 350 million people worldwide have depression. Antidepressant medications are often prescribed to treat the condition, alongside talking therapies and lifestyle changes such as regular exercise…Kerrie-Anne Ho, PhD candidate in non-invasive brain stimulation, UNSWColleen Loo, Professor of Psychiatry, University of NSW, Sydney, UNSWLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/325242014-10-06T05:10:47Z2014-10-06T05:10:47ZZapping the brain with tiny magnetic pulses improves memory<figure><img src="https://images.theconversation.com/files/60792/original/gkc9953y-1412351119.jpg?ixlib=rb-1.1.0&amp;rect=0%2C946%2C5791%2C3698&amp;q=45&amp;auto=format&amp;w=496&amp;fit=clip" /><figcaption><span class="caption">Who doesn&#39;t want more brain power?</span> <span class="attribution"><span class="source">James Steidl</span></span></figcaption></figure><p>The practice of physically stimulating the brain in order to alleviate symptoms of illness and injury has been around since the early 20th century. For example, electroconvulsive therapy (ECT) is still used to alleviate symptoms of depression.</p>
<p>However, perhaps in part due to negative connotations associated with ECT, in modern medicine treatment of psychological disorders have tended to use other forms of intervention. These now mostly involve drugs or therapy. However, a recent study, published in the journal <a href="http://dx.doi.org/10.1126/science.1252900">Science</a>, sees a return to this idea of stimulating brain regions to improve brain function.</p>
<p>Researchers at Northwestern University have shown that targeted stimulation of regions of the brain involved in the functioning of memory can enhance our ability to memorise. The method they used was not ECT, but transcranial magnetic stimulation (TMS). </p>
<p>In TMS, electromagnetic pulses are applied to the outside of the head over the part of the brain that is to be stimulated. The magnetic stimulation then induces electrical activity – that is, impulses – in those parts. Importantly, whereas ECT has to be used with anaesthetics and muscle relaxants and has side effects, TMS is a less invasive procedure. In TMS the patient is able to remain fully conscious and may only experience mild physical symptoms such as a small tapping sensation to the head.</p>
<p>In neuropsychology, the region of the brain predominantly associated with memory is the <a href="http://biology.about.com/od/anatomy/p/hippocampus.htm">hippocampus</a>. However, the hippocampus is located deep within the brain and its direct stimulation is difficult. Instead, the researchers used magnetic resonance imaging (MRI) techniques to identify regions located closer to the skull that connect with the hippocampus. They then targeted these cortical-hippocampal memory networks and tested the effects of this manipulation on memory.</p>
<p>Sixteen people were recruited for the study. Half of these people received 20 minutes of TMS stimulation to the memory networks for five consecutive days. The other half received a “sham” application of TMS to the same networks. All people were also required to take a memory test both preceding the TMS stimulation – which was treated as the baseline – and after the five days of stimulation. </p>
<p>The memory test consisted of a study phase whereby pictures of faces were paired with common words – and a subsequent test phase where people were again shown the faces and were required to recall the matching word. In addition, after the five days of TMS stimulation a second MRI scan was conducted in order to see if the “zapped” neural networks had changed.</p>
<p>The researchers found that memory in the people that had received the TMS application was improved relative to those that had received the sham TMS application. However, what caused this improvement? Did it improve specific brain networks work or just help the brain overall?</p>
<p>By conducting tests, such as stimulating regions of the motor cortex (making thumbs twitch for example) and also testing other cognitive abilities, the possibility that it was only the TMS stimulation “per se” on brain activity and function that produced the improved memory was eliminated. Also, MRI scans revealed increased connectivity in the brain networks targeted. </p>
<p>The authors of the study note that this procedure is not a cure for memory disorders following neurological illnesses or brain injury. Rather the application offers insight into the possibility of an alternative form of intervention than drugs for illnesses such as Alzheimer’s. </p>
<p>The problem with pharmacological intervention – that is, the use of drugs – is that it is hard to target specific regions of the brain – and due to this non-selectiveness many drugs have unwanted side effects. It is the recognition of the ability of TMS to target specific regions of the brain that offers the promise of a new approach to recovery of brain function following brain injury and illness.</p>
<p>Incidentally, if you are also envisaging some kind of futuristic alternative to smart drugs – such as that found in the movies Limitless or Lucy – you are probably <a href="http://www.bbc.co.uk/news/health-15600900">not the only one</a>. For now, however, the research focus is firmly clinical with the view to improving the lives of those with debilitating memory disorders.</p><img src="https://counter.theconversation.com/content/32524/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elizabeth Maratos does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The practice of physically stimulating the brain in order to alleviate symptoms of illness and injury has been around since the early 20th century. For example, electroconvulsive therapy (ECT) is still…Elizabeth Maratos, Teaching Fellow and Teaching Assistant, University of LeicesterLicensed as Creative Commons – attribution, no derivatives.